Acute soreness in your muscles after any workout is a relatively normal phenomenon. It typically occurs with lactic acid build-up and is felt hours to a day after physical activity.

Delayed onset muscle soreness (DOMS) results after strenuous physical activity and presents as muscle soreness one to three days after exercise. This is a result of microtears in the muscle tissue resulting in inflammation in the tissue. Both phenomena are typical characteristics of muscle building as a result of increased physical activity. Both phenomena are easily treated and self-limiting with proper hydration, stretching, warm-up, warm down, and rest time.

If the soreness lasts for more than several days or becomes more intense, evaluation by a trained professional is recommended. In addition, soreness in the muscle bellies being trained is typical. Still, a more serious problem may exist when pain is located in the tendon insertions (e.g., Achilles tendon, patellar tendon, biceps tendon). If this type of pain persists or worsens, then once again, evaluation with a trained professional is recommended.

The knee is the largest joint in the body, making it vulnerable to many problems. Being aware of these problems and how to prevent them can help keep your knees healthy throughout your life, says Frederick Song, MD, an orthopedist on staff at University Medical Center at Princeton (UMCP).

Overuse injuries: In young athletes, overuse injuries are increasingly common, including patellofemoral syndrome, a dull pain caused by irritation under the knee cap. These injuries are often caused by playing the same sport year-round, weakening muscles that protect the knee. Playing different sports during different times of the year can help prevent injuries by working different muscle groups. “The number one way to treat overuse injuries is to temporarily stop playing that sport and work on a supervised strengthening program.” Dr. Song says. “It’s hard for parents and athletes to commit to stopping, but it can prevent more serious problems.”

Traumatic injuries: Sudden injuries from acute deceleration or cutting with or without contact are common in youth athletes and young- and middle-aged adults. These injuries include ligament tears and tears of the meniscus, the fibrocartilage that acts as a shock absorber between knee bones. Adults who participate in sports should also vary their activities and perform exercises to strengthen the hamstrings and quadriceps — muscles that support the knee. Keeping your core muscles strong is also essential for injury prevention. For tears, treatment usually involves surgery to remove or repair the damaged meniscus or reconstruct the ligament.

Degenerative injuries: In adults over 50, the most common knee problem is osteoarthritis, the gradual breakdown, and loss of cartilage. It’s challenging to prevent arthritis, but keeping your weight down, strengthening the muscles surrounding the knee, and focusing on low-impact exercises such as swimming and biking can help. Osteoarthritis is first treated conservatively with physical therapy and anti-inflammatory medication. Second-line treatments include injections to reduce pain or improve lubrication in the knee. “If a patient exhausts all of those treatments and continues to have pain that affects their daily activity,” Dr. Song says, “then we discuss knee replacement.”

When to see a doctor

Sudden pain and swelling due to injury should be evaluated as soon as possible. Swelling that comes on gradually, and doesn’t improve in a matter of days with rest and ice, should also be brought to your doctor’s attention.

As the largest joint in the body, the knee is one of the most easily injured.

Millions of people visit their doctor every year because of common knee problems, including fractures, ligament and cartilage tears, overuse injuries, and osteoarthritis.
So how do you keep your knees strong and help protect them from injury?

Put simply, keep your muscles strong. (and keep your weight down)

Vulnerable to Injury

Your knees provide stable support for your body and allow your legs to bend and straighten. They are aided by the muscles in the front of your thigh (quadriceps) and the back of your thigh (hamstrings). Because they (are) made up of many components – bones, cartilage, ligaments, and tendons – your knees are vulnerable to various injuries.

Athletes of all ages – from the high school soccer star to the middle-aged weekend warrior – are susceptible to acute injuries like tears to the anterior cruciate ligament (ACL) and the meniscus (as well as traumatic cartilage injuries).

Additionally, athletes, particularly young athletes who (specialize) in only one sport year-round, are at high risk for overuse injuries, including:

Further, young athletes are also at greater risk for growth plate injuries. Growth plates are areas of developing cartilage at the ends of long bones where bone growth occurs in children. When the growth plate is injured, it can fracture and disrupt average bone growth.

(Several studies have demonstrated that if a young athlete who is skeletally immature (growth plates are still open) specializes in one sport year-round, they have a 15-20x increased chance of musculoskeletal injuries compared with the same athlete that participates in multiple sports during the same period.) Simply put, young athletes should be encouraged to participate in a variety of sports up until they are more skeletally mature (15-16 years old for boys and 13-14 years old for girls).

As you age, knee problems are generally associated with osteoarthritis, resulting from wear and tear on the joint. With osteoarthritis, the protective cartilage in the knee gradually wears away, resulting in bone rubbing on bone.

According to the Centers for Disease Control and Prevention, osteoarthritis affects more than 30 million adults in the United States.

In addition to age, risk factors for osteoarthritis include:

Symptoms of a knee problem depend on the type of injury or condition. However, most knee problems cause pain and may limit your availability to move your knee. (Knee swelling can also indicate a structural issue.)

Diagnosing and Treating

Doctors can often diagnose knee problems with a medical history and physical exam. We may recommend x-rays and other imaging tests to confirm the problem.
Treatment depends on the condition, but it involves physical therapy to strengthen the knee and the muscles surrounding it in most cases. We can usually treat tendon injuries with rest, ice, compression, and elevation. Our team may treat osteoarthritis with anti-inflammatory (medications) or cortisone (steroid) injections to reduce pain and swelling.

If knee injuries do not respond to conservative treatments, surgery may be necessary.

At the University Medical Center of Princeton (UMCP), board-certified orthopedic specialists, also experts in sports medicine, offer advanced, minimally invasive techniques to treat knee conditions.

We can often treat sports injuries (including ligament and meniscal damage) with arthroscopic surgery, a minimally invasive procedure that enables doctors to examine and repair (or reconstruct) tissues inside (the knee) through small incisions around the joint.

Newer forms of treatment for knee injuries, including injecting platelet-rich plasma or bone marrow (aspirate) concentrate into the affected joint, have not yet been proven to be any more effective than current treatment methods, though research is continuing. This field of orthobiologics will likely enhance treatment options for all joint disorders in the future.

Protecting Your Knees

You cannot avoid some knee problems, but you can prevent many conditions by doing the following:

It is important to note that exercise, including low-impact movement, can help relieve symptoms and slow the progression even if you have osteoarthritis.

If you suffer from knee pain or injury, talk to your doctor before the condition worsens. Often, physical therapy and medication will be enough to get you back on the field or back to your normal activities in no time.

I was referred to Dr. Rossy by my general practitioner. Following surgery, I can say with measured honesty that Dr. Rossy is excellent at what he does. He is professionally personable and will answer all your questions to allay any anxiety one may have. He offers a truthful and honest opinion regarding diagnosis and surgical outcomes. Sekena, his personal assistant, is very efficient. I would highly recommend this team at POA to take genuine care of your orthopaedic needs. Thank you both and your team for the excellent care.

Diane F.

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