The knee is the largest joint in the body, where the thighbone (femur), shinbone (tibia), and kneecap (patella) connect. It also includes cartilage, ligaments, menisci, and tendons. When everything is working as it should, the knee joint functions properly – allowing for free movement without pain. However, if any part of the knee joint is not working well, pain, inflammation, and other symptoms can make it difficult to walk and participate in daily activities.
Chronic knee pain is common. It can be the long-term result of an injury, such as when someone falls or receives a blow to the knee. However, it is most often caused by everyday wear and tear, overuse, or by certain medical conditions. Sources of chronic knee pain include:
Patellofemoral syndrome (sometimes called “runner’s knee” or “jumper’s knee”)
Patients who experience knee pain often have other symptoms, such as swelling/stiffness, redness/warmth to the touch, weakness, instability, popping noises when bending, or inability to straighten the knee. If you cannot bear any weight on your knee or are unable to extend/flex your knee, contact your doctor or pain management specialist. Long-term knee pain can lead to permanent damage to the knee and loss of function.
Physical therapy to rehabilitate the knee and prevent future injuries and medication therapy are often the first steps in treating chronic knee pain. If there is no sign of improvement or reduced pain, your pain specialist may recommend other treatment options. Some other effective minimally invasive techniques are injections including corticosteroids (to reduce inflammation) and hyaluronic acid (to help cushion and lubricate the moving parts within the knee). If conservative therapies do not improve a patient’s condition within six months, surgery may become an option. Arthroscopic surgery, partial knee replacement surgery, and total knee replacement surgery are the three most common kinds of surgeries to improve knee pain.
When it comes to keeping your body strong and healthy, you’re encouraged to eat well, get adequate sleep, and, of course, exercise regularly. But this is a lot easier said than done when you’re experiencing ongoing pain.
Knee pain can be excruciating, making even the lightest workouts difficult. But what exactly is causing this pain? And are there ways to relieve it and get back to living actively without pain?
Technically called Patellofemoral Pain Syndrome, a runner’s knee is when you have pain in front of, around, or behind your kneecap when performing any activity requiring you to bend your knee, including walking, getting up, squatting, running, etc. You might even notice increased pain when walking downstairs or downhill.
Other symptoms might include rubbing, grinding, or clicking when bending and straightening your knee and a tender kneecap.
Ultimately, no. If you’re experiencing knee pain after exercising, you need to rest it until the pain dissipates. If it returns during use again, then you’ve likely got a bigger problem that self-care and home remedies won’t resolve.
Don’t rush! You’ll know you’re ready to get back out there if:
You bend and straighten your knee without pain
Your knee is painless when walking, jogging, sprinting, jumping, etc.
There are plenty of ways to treat your knee pain after running:
Rest It. Don’t make your knee problem worse by using it before it’s ready. Give your knee a rest and avoid any activity that’ll strain it, including walking if you must.
Ice It. Fight back against the pain and swelling with 20-30 minute icing sessions every few hours for up to 3 days.
Wrap It. Give your knee some support with elastic bandaging, patellar straps, or sleeves.
Elevate It. Take some pressure off by elevating your leg with a pillow when sitting or lying down.
Take NSAIDs. If you need a little extra help for staving off high-level pain, the likes of ibuprofen or naproxen are options for temporary pain relief. But be careful as NSAIDs may have side effects as well as risks. Use as directed and always consult your doctor with any questions before use.
Stretch and Strengthen. Strengthen the muscles and ligaments supporting your knee such as the quadriceps. Consult your doctor for physical therapy if you are considering this option.
Arch Supports or Orthotics. These will help correct your foot positioning, which could very well cause knee pain.
How Do I Stop My Inner Knee from Hurting When I Run?
Some proactive measures you can take to prevent Runner’s Knee include:
If resting your knee and other methods aren’t enough to resolve your runner’s knee pain, you may have damaged cartilage or a displaced kneecap, which may require surgery.
Cortisone joint injections can temporarily alleviate knee pain as it recovers, but it’s important to consider more permanent options to live comfortably long term.
Suffering from a chronic condition such as diabetes can be debilitating, and the treatment can be expensive, stressful, and time-consuming. It can become an even bigger issue when a separate chronic condition arises, such as diabetic neuropathy.
Pain management for diabetic neuropathy has become a focus of pain specialists as more and more patients experience this painful and exhausting side effect of diabetes. Effectively treating it can improve your overall quality of life and daily level of function.
Diabetic neuropathy is nerve damage that develops through type 1 and 2 diabetes. Your nerves are bundles of tissue that carry signals between your brain and other parts of the body to control limb and organ functions.
Diabetic neuropathy often affects the legs and feet, and while some cases are mild, many of them are painful, debilitating, and can even be fatal in certain circumstances. The chance of getting any case of diabetic neuropathy increases the older you are and the longer you have diabetes, meaning that treating it sooner can save you a great deal of pain – or even your life.
Over time, high blood glucose levels (aka blood sugar) and fat levels in the blood from diabetes can damage your nerves. Additionally, there can be damage to the small blood vessels that nourish your nerves with oxygen and nutrients caused by these elevated levels.
Each person’s target blood sugar level for diabetes maintenance differs, making it tough to assign an exact number. However, this makes it even more important to communicate with your pain clinician or primary doctor about how best to manage these levels.
Additional Causes of Diabetic Neuropathy
Research suggests there’s a potential hereditary link to diabetic neuropathy. However, even within these studies, the most prevalent conditions present in patients with diabetic neuropathy include:
If you are diabetic or pre-diabetic and believe you are suffering from any of these conditions, we recommend talking to your doctor or a pain specialist about prevention steps for diabetic neuropathy.
Diabetic neuropathy is painful due to several metabolic and vascular factors that affect different parts of the body. These include increased sorbitol, fructose, glycol end products, and reactive oxygen species in the blood.
Day-to-day indication of diabetic neuropathy includes excruciating burning and stabbing sensations that are both unpredictable and persistent when they do occur. These are not easily treated by any over-the-counter drug, making prevention and pain management all the more important to discuss with your doctor.
Why is Diabetic Neuropathy Worse at Night?
The symptoms of diabetic neuropathy can flare up for several reasons, including:
CoolerTemperatures: Neuropathy in your feet is often more prone to cool air. As the temperature drops, your pain and numbness might increase.
Stress: The end of a long day can bring a buildup of physical stress and mental exertion. This might cause your body to be taxed and your neuropathy to react violently.
Fewer Distractions: We often push through pain in our daily life because we need to work, care for our family, or attend to daily tasks. As we lie still and try to drift off, the accrued pain and flare-ups of the day may be harder to ignore.
These factors may all increase at night, but your symptoms may vary and worsen at any time. Contact your doctor immediately if you are experiencing persistent pain or numbness in concurrence with diabetes.
Neuropathies progress slowly in general, and diabetic neuropathy is no exception. Diabetes is often referred to as “The Silent Killer,” and diabetic neuropathy is no exception.
For many, the underlying conditions contributing to diabetes also exacerbate diabetic neuropathy: poor diet, weight fluctuation, and other lifestyle choices that allow for glycemic fluctuation.
Last month, we wrote on the topic of headaches and dehydration, especially during the hot summer months. But with the monsoon season in full swing, the changes in weather also bring what some have dubbed as “migraine season.” As the summer storms roll in, our pain specialists see an increase in appointments and complaints from weather-related chronic pain symptoms, including migraines.
While we spend a lot of time and focus on dehydration and staying cool during the summer months, this is also the time of year that we like to discuss how changes in barometric pressure can affect chronic pain, namely migraines. Barometric pressure, another term for atmospheric pressure, is the force put on our bodies by the air around us. With the monsoon storms come a sharp drop in barometric pressure and an increase in humidity. While many studies have been conducted to prove or disprove, the connection between migraines and barometric pressure, there has been little scientific evidence to go either way. However, if you suffer from migraines you know that the weather plays a huge role in how you’re feeling that day.
Any United States pain doctor will tell you how important it is to keep stress levels low and reduce anxiety to control pain. However, during the monsoon season, when atmospheric pressure plays a role in pain management, anxiety regarding the weather patterns can be difficult to control. It’s a vicious cycle; increased pressure in the atmosphere due to oncoming storms leads to increased pain, which leads to increased anxiety, which only makes matters worse. Before you know it, your body is trained to feel increased pain at the very thought of a summer monsoon.
There’s not much you can do to stop the barometric pressure from falling, and whether you’re indoors or outdoors this change in air pressure will follow you. When you know a storm is coming, do your best to reduce stress by creating distractions. Perhaps go to a movie where you’ll be indoors through the worst of the storm. Or, as many of our patients do, draw up a warm Epsom salt bath, grab a good book and a cup of herbal tea, and relax as the storm blows by.
Headaches are often thought of occurring as a sign of a larger problem, and in most cases, this is true. Headaches frequently accompany colds, flu, chronic pain, and even food poisoning. However, sometimes headaches occur seemingly at random, but there may actually be a reason – dehydration.
Believe it or not, dehydration can cause headaches. Dehydration occurs when we lose more fluids than we put in, and the body doesn’t have enough water and other fluids to carry out its normal functions. Dehydration can occur in any age group, and there are several causes. Diarrhea and vomiting can lead to dehydration, as can increase urination. However, in the hot summer months, the main cause of dehydration is not drinking enough water or fluids to replace the water lost when you sweat. If you do vigorous activity – or are simply enjoying our hot summer climate – and don’t replace fluids as you go, you can become dehydrated.
A variety of unpleasant symptoms occur when this happens, including headaches. Dehydration headaches may cause pain at the front, back, or on just one side of the head, or the pain may be felt throughout the entire head. Bending the head down or moving it from side to side often worsens the headache. Even simply walking can cause more head pain.
The initial symptoms of dehydration include thirst and minor discomfort, but can also include the following prior to, or during a dehydration headache:
A decrease in urine output, and urine that is dark or amber in color, is also a sign of dehydration. Severe dehydration can lead to low blood pressure, swelling of the tongue, unconsciousness, and even death in the most extreme cases. Seek medical attention right away if you experience extreme thirst, feel unusually tired (lethargic) or confused, have not passed urine for eight hours, have a rapid heartbeat, or experience dizziness when you stand up that doesn’t go away after a few seconds.
The key to avoiding a dehydration headache is by staying hydrated. Most people need 4 to 6 cups of water per day, though some may need to drink more or less. During exercise or exposure to hot weather, you will need to drink more fluids to replace the water lost through sweat.
You can also help maintain an adequate fluid intake by eating foods that are naturally high in water content, such as vegetables and fruits.
It’s important to note that not all fluids are equal when it comes to fluid replacement. Coffee and alcohol are bad choices since both acts as diuretics. These types of beverages promote urination and fluid loss and can cause or exacerbate dehydration and headaches. If someone is chronically dehydrated, they may not always feel thirsty before becoming dehydrated. That’s why it’s important to listen to the body in other ways and look for dry skin, dark urine, dry eyes, and other signs.
If you experience a dehydration headache, increase your fluid intake, replace lost electrolytes with a sports drink, decrease your physical activity and avoid heat to reduce sweating. While 16 to 32 ounces of water or fluids should do the trick, drinking too much too quickly can lead to a sluggish, bloated feeling, so it is best to gradually consume water every 10 minutes or so. For severe dehydration, you may need to slowly lie down and drink more fluids. In extreme cases, intravenous (IV) rehydration may be necessary.
Drinking enough water does more than just prevent dehydration headaches – it can also prevent migraines. While we do not know exactly what causes a migraine, we do know that dehydration is a known trigger for migraine headaches. One study even showed that when the study participants drank more water each day, they had fewer symptoms and less severe migraines overall.
If you suffer from fibromyalgia, you may find it difficult to continue working because of the potentially debilitating symptoms, and this can cause financial difficulties. If you are currently paying into a pension, you can only access the money from age 55. However, you may be eligible to claim an ill-health early retirement pension before then, and this will allow you to continue to receive an income.
What is an ill-health early retirement claim, and can you claim it for fibromyalgia?
If you are unfit or unable to work due to fibromyalgia, you can claim an ill-health retirement claim, otherwise known as being ‘medically retired. This allows you to receive your pension benefits before the age of 55 if you are unable to work due to a permanent illness or condition. You can also make a claim if your fibromyalgia dramatically reduces how much you could potentially be able to earn.
Everyone experiences fibromyalgia differently. Some people are able to continue working and complete tasks normally, occasionally suffering from flare-ups’. However, for some, the condition can be debilitating, making it extremely difficult, and sometimes even impossible, to continue working. Symptoms can be so severe that it causes difficulty in completing even day-to-day tasks and commonly include widespread pain and tenderness, headaches, fatigue, cognitive problems, and extreme sensitivity. There is currently no cure, but medications and other techniques are used to manage the pain.
Symptoms of fibromyalgia, such as extreme tiredness, problems with mental processes such as memory and concentration, muscle stiffness, and widespread pain can cause difficulties working long hours, especially in jobs that require physical work. Too much physical and mental stress on the body can cause severe flare-ups and even exacerbate the condition. It is important to avoid working at a job that can have a negative effect on your health.
Before making a claim, you may want to request that your employer makes adjustments to your workplace to enable you to continue working to the best of your ability. As long as they are considered reasonable adjustments, you have the right to make these requests to prevent you from being disadvantaged at work. This can allow you to continue working for longer and enable you to earn an income that may be beneficial to your mental health. These changes may include your employer offering you flexible working hours, additional rest breaks, and task rotation to combat the common symptoms of fatigue. They may also reduce the number of physical tasks required of you, shorten your hours or allow you to work from home. Furthermore, they may amend and change your work duties if your doctor believes that they might exacerbate your fibromyalgia.
In order to make an ill-health early retirement pension claim, there are certain criteria you need to prove. You need to demonstrate that you are permanently incapable of returning to work and that there are no other medications or treatments that can be explored to allow you to return to your job before the normal pension age. You will also need to show that you cannot work at a similar alternative job.
If you make a claim, the first step is to complete the ill-health early retirement pension application. You can receive this from your pension scheme. You will need medical proof which you should receive from a consultation with a rheumatologist who fully understands fibromyalgia. They will give an expert opinion on whether they believe you are able to work or permanently unfit to carry out the duties required of you at work. Your employer will then be required to confirm that ill health is the only reason you are making this claim and retiring.
With a report from a professional, you have very reasonable prospects of being able to claim an ill-health early retirement pension. However, there is a possibility that your claim may not be successful, but it is possible to submit an appeal and potentially receive an ill-health pension with new medical evidence.
I have been turned down on my income protection claim because of a report commissioned by my insurance company from a company doing CPAD (chronic pain abilities determination). The tests were conducted by an osteopath who is also a functional capacity assessor. I have been unable to locate details of any clinical trials on CPAD, and have found no evidence that the test has been medically proven nor that a CPAD assessment has been published in a peer-reviewed medical journal. Is CPAD medically proven?
I have not come across CPAD, but the clue to this is that the osteopath is a functional capacity assessor. The tests that you have had to undergo sound very much like functional capacity assessments.
These assessments are notorious among fibromyalgia sufferers. They are often very technical, complex, and detailed to the point where the reports are extremely hard to understand. The crucial point is that such assessments have very little relevance to fibromyalgia sufferers. They may well be extremely useful in evaluating functional impairment in those with structural musculoskeletal damage, but fibromyalgia sufferers will generally have entirely normal musculoskeletal structures. Their difficulties are the constant symptoms of pain, stiffness, and feelings of weakness.
Therefore, fibromyalgia sufferers may well be able to carry out many of the tasks, slowly and in pain as a one-off activity, but that is very unlikely to translate into being able to do these normal daily tasks on a regular and sustained basis. In other words, these types of tests are not a fair reflection of the functional impairment of the fibromyalgia sufferer. It is also true to say that on the day of the assessment the fibromyalgia sufferer may have fewer symptoms than on other days.
My advice is to try to avoid undergoing these assessments wherever possible. Insurers should be told that they are simply not meant for fibromyalgia sufferers. If the insurer insists, however, the assessments may have to be done, but it is then always advisable to have a report from a consultant rheumatologist who would be able to comment on your ability to sustain activity and who is a “bigger hitter” than the osteopath or similar who carries out the functional capacity evaluations.
Ronty Rhodes Solicitors recently represented Mrs. Adams who suffers from Fibromyalgia. She was dismissed on the grounds of ill health in July 2011 but received her last sick pay in March 2011. She submitted an application for Ill Health Retirement in August 2011 and the application was rejected in September 2011.
Mrs. Adams came to us in January 2013 to instruct us to appeal against the decision on Teachers’ Pensions in January 2013.
We reviewed the various medical evidence, reverted to some of the experts, and prepared a full and comprehensive Letter of Appeal in February 2013. The appeal was successful in March 2013 with the application for Ill Health Retirement being accepted.
Living with a chronic pain condition, such as fibromyalgia, can be difficult enough in itself but, when it comes to relationships, it can also cause additional complications. Aside from the pain associated with fibromyalgia, the illness often has a negative impact on the patient’s emotional well-being.
The combination of these two elements alone can place an understandable strain upon both partners in a relationship. In fact, a study published by the US National Institute of Health concluded that:
“In addition to physical impairments that are well documented among individuals with fibromyalgia, fibromyalgia can result in a substantial negative impact on important relationships with family and close friends.”
Some of the relationship pressures described by those suffering from fibromyalgia include:
From the perspective of someone whose partner suffers from a chronic pain illness, the difficulty of watching a loved one go through pain and suffering (as well as feeling the impact of the associated negative emotions) can also be challenging: as one partner of a fibromyalgia sufferer (known as ctc315 on the related fibromyalgia community chatroom) details:
“My wife is a wonderful, loving woman, but sometimes she just is angry, kind of like a PMS or Menopausal thing. It is a side effect of the Savella and I know this and I make allowances for her disposition. Of course, she always apologizes afterward, but it can be quite challenging.”
On an internet community discussion board relating to the subject of “living with someone with fibromyalgia”, the following fibromyalgia patients summed up a few of the difficulties involved in a relationship where chronic pain plays a factor:
#1 ISSUE: “It’s not that he doesn’t believe me (though that took years) but I still have to ask for each little thing, and that is very draining. It just doesn’t occur to him.”
#2 ISSUE: “With my gent, he sometimes wants to go, go, go, and doesn’t really understand when I say that I need to stop.”
#3 ISSUE: “I shut him out, I get paranoid he doesn’t believe me, I get upset because I want to do more, then I get angry that I can’t do more. I feel like I’m letting him down by not getting better faster.”
In summary, two major factors that may place particular stress on a couple, where one partner suffers from fibromyalgia are
#1 LACK OF SUPPORT: Fibromyalgia can be difficult to diagnose, potentially causing the strain of a lack of support being felt by the sufferer if they don’t feel that their partner is convinced by their symptoms
#2 UNPREDICTABLE SYMPTOMS: The symptoms of fibromyalgia may vary from day to day. This may add additional pressure on the relationship in terms of forward planning for shared time together, as well as the unpredictability of moods and pain levels
In 2010, research was undertaken by the University of Missouri, investigating: “the interactions of married couples that include one spouse who has been diagnosed with fibromyalgia or chronic widespread pain”. As Christine Proulx, Assistant Professor of Human Development and Family Studies explains: “fibromyalgia is very hard on both spouses because their lives are changed dramatically.”
So, if you are in a relationship and suffer from fibromyalgia, what steps can you take to help your partner to understand and support you more effectively? We’ve put together the following three tips to help you out:
#1 EDUCATE: Try to inform your partner as much as possible about the nature of your illness. Share relevant articles and websitesabout fibromyalgia with them, and describe how your own particular symptoms can affect your mood and pain levels
#2 COMMUNICATE: Let your partner know when you are having a particularly tough day and calmly explain why certain tasks may be more difficult/unachievable for you. Try to refrain from taking your pain/frustration out on your partner as we often, unfairly, take things out on those closest to us when we aren’t feeling our best
#3 THINK POSITIVELY: If unavoidable symptoms prevent you from undertaking daily tasks, or a planned day trip, try to remain positive and find a way to work around the issue. For example, calmly explain to your partner the reasons that you cannot keep to the existing plans, and work out if it is possible to reschedule for a future date, once the flare has subsided
It’s important to remember that living with fibromyalgia does not mean the kiss of death for your relationship by any means! Love, respect, patience, and making time for fun are all keys when it comes to any long-lasting and happy partnership.
At first, my illnesses would require a little more rest while away. Because I pushed through pain and fatigue in hopes of keeping up with my family, I always returned home feeling like death. It was not unusual for my body to need days, weeks, and a few times months to recover from a week away from home.
Through the years I have not only made changes to how I address and relieve my chronic pain, but I have made changes to how I vacation too!
Here are a few tips to help you better enjoy your summer vacation!
Do a little research. Locate pharmacies, hospitals, and urgent care facilities that are in close proximity to your hotel. Then verify that they accept your health insurance.
Speaking of health insurance, check with your provider to see what your coverage is while in a different state or country.
Have your most important medicalinformation handy in case of an emergency. Click here to download my free Emergency Wallet Card. Perfect for when you are not able to inform emergency personnel of your health history or allergies. Always inform your traveling companions of their whereabouts so they can access them easily in case of an emergency.
