There are two main types of knee injuries:
Acute injuries: which result from sudden trauma, such as an awkward fall, collision or twist of the knee joint.
Overuse injuries: which result from continuous activity or overload, such as running, jumping and cycling. These types of injuries start gradually and usually relate to a range of factors such as structural or biomechanical problems, training methods, incorrect footwear, incorrect techniques in the workplace and incorrect exercise style.
From APA 2017
When pain has been present for only a few days or weeks, it’s called acute pain. This is what you feel immediately you hurt or burn yourself. Acute pain does not last very long (usually days or weeks) and generally disappears quickly as
your damaged body tissue recovers and heals.
Acute pain is considered a normal and protective sensation that alerts us to an injury or tissue damage and causes us to seek medical attention to help with treatment.
Acute pain is useful and protects us.
Chronic pain is useless to the body and does not protect us. It is an abnormal sensation because it shouldn’t be there. If there is no tissue damage, because the tissue has already healed, then there should not be any pain.
Chronic pain is an unexpected response of the body to tissue or nerve inflammation or damage that has occurred in the past. The brain remembers it.
The actual pain of chronic pain may also feel different to the everyday aches and pains we all experience. This is because with most types of chronic pain parts of the nervous system and nerves have becomeactivated or sensitised. We call this type of chronic pain, neuropathic pain as it feels like nerve pain.
Chronic pain can be prolonged or maintained or even worsened by a range of factors, not necessarily to the amount of damage that did occur.
Factors prolonging chronic pain include:
Genetics – Our DNA and genetic characteristics may be responsible for the pain that we feel and experience.
Specific genes have been identified but aren’t usually tested for.
Women and men feel the same pain differently. Women can feel pain more
intensely than men and can suffer disproportionately from conditions like migraines and fibromyalgia. This might be related to hormonal differences or cultural differences. Men are sometimes less likely to take their pain seriously or are less likely to talk about their pain or seek help.
Stress may have serious and detrimental effects on your body and can worsen chronic pain. Stress causes an upset in the equilibrium of your
body. When this occurs, stress causes a wide range of physical and emotional problems. It does this by activating and therefore causing imbalances in your nervous, hormone and immune systems.
The reactions then lead to physical and emotional changes with short and long-term effects on the body. You feel more pain.
The way you experience pain can be influenced by:
Major depression is the most common mental illness associated with chronic pain. If you are experiencing chronic pain, there is a 30-40% chance that
you will also have some type of depression. The link between depression and pain is complex. They may be linked by:
1. The physical and emotional effects of chronic pain might trigger an episode of major depression. This can particularly occur in people that have had depression before they got the pain.
2. Depression itself may somehow make the pain worse or even be a trigger for the pain. People with depression, who experience pain on top of the depression generally feel more pain.
3. The pain and depression may be triggered by a medical problem. The chronic pain and major depression may both arise out of a common underlying process, like fibromyalgia.
Medications like opioids (morphine or oxycodone [Oxycontin, Endone]) can actually worsen pain. The condition is called Opioid Induced Hyperalgesia (OIH).
This concept is supported by good scientific research.
When the doses of most opioid medications like morphine, Oxycontin/Targin Endone are high, e.g. more than 50mg per day, it can start making the pain worse. The same thing can happen to people using an opioid patch like Fentanyl.
When taking these medications the following things can occur:
• People become more sensitive to pain, not less sensitive
• The pain continues to worsen despite the doses of those medications being increased
• The pain can even change and become more widespread and cover a wider area of the body
• Even sensations that are not normally painful, like stroking the skin with cotton wool, can become painful.
Sensitisation is when opioid-induced hyperalgesia occurs because the nervous system becomes more activated and not de-activated
Taking too much opioid medication can also lead to problems like:
• Dependence (addiction).
• Risk of overdose, which can be very dangerous and even fatal.
• Hormonal changes.
• Chronic dry mouth (which can cause tooth decay).
• Bone weakness and fractures from minor falls.
• Chronic constipation.
• Problems with sleep.
Patients with opioid-induced hyperalgesia generally benefit from slowly reducing or discontinuing their opioid medications. It might also be beneficial to start other non-opioid medications. In some situations switching to a different opioid may be useful but opioid-induced hyperalgesia can occur with almost any opioid medication.
If you think you may have opioid-induced hyperalgesia, you should talk to your general practitioner or pain specialist.
People with chronic pain use words like, hot, burning, scalding, searing, cold, freezing, quivering, pulsing, throbbing, beating, pounding, sharp, shooting, cutting, lacerating, stabbing, stinging, lancinating comment pinching, pressing, gnawing, crushing, nagging, seeking, agonising, punishing, exhausting, aching or stabbing pain, cramping.
The two main ways the chronic pain manifests:
1. The actual pain itself – this can have many different types of descriptors as described above and the pain can occur in any place on or in your body like your face and head, shoulders, neck, spine, back, hips and legs. Literally, any part of your body may develop pain.
2. Then there are the effects that the ongoing pain has on you personally and your lifestyle, which will now be described.
Chronic pain has a number of long-term detrimental consequences that we call “the downward spiral of pain”.
Maladaptive thought – Movement triggers pain, and you think and feel that you will damage something when you move, so you minimise movement and rest excessively.
Excessive rest leads to a boom-bust cycle of activity. This means you wait until the pain is reduced and then you exert yourself physically
and are over-active until the pain flares up and becomes so severe again, that it forces you to stop and have a long rest again. You then wait for the pain to be reduced. Once the pain is reduced
you feel better and the cycle begins again.
– The boom-bust cycle reinforces the link between activity and pain i.e. that movement will hurt and make it worse. This is a maladaptive cognition (thought), which then leads to that safety-behavior which can then cause further inactivity and rest.
This then leads to deconditioning and deconditioning has consequences too.
– Deconditioning is a complex process of physical and emotional changes that occur in your body after a prolonged period of inactivity or rest.
Deconditioning can even occur to people that lead an inactive lifestyle. The consequences of deconditioning can include: weakness, stiffness,
fatigue, poor sleep, overweight, frustrated, being angry, low confidence, depressed, anxious, isolated, poor relationships and inability to be productive
Deconditioning is serious and can even be quite dangerous. It can put you at risk of high blood pressure, heart attacks and even strokes. It causes a reduction in your quality of life. – This is the downward spiral of chronic pain.
As a Specialist Musculoskeletal Physiotherapist at In Touch Physiotherapy in Subiaco, I assess clients for a second opinion.
This is valuable when clients are not achieving good outcomes from other physiotherapy treatment.
I review compensation clients (with a referral from a GP, Specialist doctor or Insurance Company). I also see private clients (with referral from their doctor, physiotherapist or via self-referral.)
After a comprehensive assessment I provide a written summary of my main findings, a diagnosis or classification, and analysis of how this fit with the client’s main problem. I make suggestions for alternative physiotherapy approaches, or medical assessment, investigative diagnostics or procedures as needed.
I welcome treating physiotherapist to attend their clients’ assessment. My aim is to empower your client with accurate information, a clear diagnosis, or categorisation of their problem and to help you their physiotherapist to help them to progress more efficiently and achieve a better outcome.
If you would like to know more please phone Helen 93816166 or firstname.lastname@example.org
Seek help from a Specialist Physiotherapist with forty years experience offering effective dynamic treatment.
For any problem you have with pain, movement, activity or posture.
Don’t wait to live life after surgery. I can improve osteoarthritis pain and limitation in the hip, knee and foot with evidence-based advice, specific treatment and reduction of negative lifestyle factors.
If you would like to know more, please phone Helen 93816166 or email@example.com
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