At Home with Chris Jessen 2018 - 147
Changing the way you
walk can work wonders
to reduce knee pain
atients with knee pain will
often limp, as this reduces
the load across the joint.
It's an automatic response
from the brain to turn off the powerful
quadriceps muscles at the front of the
thigh, giving control of the knee to the
calf and hamstrings.
This can work to relieve pain in the
short-term, but if limping continues,
these muscles at the back of the leg
will become overworked and then
cramp painfully. Because the calf and
hamstring muscles are unable to get
the knee completely ﬂat at the back, the
patient will walk on a slightly bent knee,
exacerbating any swelling and pain.
Most limping resolves spontaneously,
but sometimes it becomes a habit,
leaving the patient worse off than before.
The quadriceps muscles can weaken
ARTHRITIS OF THE
KNEE CAUSES PAIN... IF
LIMPING IS PRESENT
TOO, THIS WILL DOUBLE
and reduce in size because they have
been bypassed when walking.
Conventional physiotherapy consists
of strengthening the quadriceps, but if
the ingrained limping pattern persists,
quadriceps exercises on their own will
not make up for the workout these
muscles would get with normal walking.
Patients need to be taught to walk
Gait analysis and re-education can
usually be undertaken in a clinic, but
occasionally the facilities of a gait
laboratory are required. Mr Jamie
Flanagan runs a gait assessment clinic
at the Chelmsford Knee Clinic and works
MEET THE EXPERT
Mr Jamie Flanagan,
FRCS, trained at
and set up the
clinic in 1996.
He treats the full
spectrum of knee problems from sports
injuries to arthritis. He has a special
interest in gait rehabilitation.
closely with the gait and motion analysis
laboratory at Anglia Ruskin University.
Limping with arthritis
Arthritis of the knee causes generalised
pain, which gets worse with walking.
If limping is present too, this will usually
double the symptoms.
Limping can come and go, which
explains why symptoms may ﬂuctuate.
If the limping pattern becomes
ingrained, symptoms can be more
severe than an X-ray would suggest.
Gait retraining to eliminate limping
will reduce symptoms and often allows
a knee replacement operation to be
postponed or avoided altogether.
Many patients having a total knee
replacement will have an ingrained limp
accounting for a signiﬁcant proportion
of their symptoms. A successful knee
replacement will remove the arthritic pain.
Most patients will spontaneously stop
limping as a result, but in some cases,
this can take up to a year or more.
The limping pattern is so ingrained
in some patients that it probably
accounts for the 20% of people who are
dissatisﬁed following an apparently
satisfactory knee replacement operation.
These patients will not respond to
standard rehabilitation and need to
be taught how to walk normally again.
What counts as limping?
You are almost certainly limping if:
You have generalised pain around
the front of your knee
Your knee is swollen
You have pain in your calf or down
the side of your thigh
Your knee remains slightly bent
You have to use your arms to pull
yourself while climbing stairs
The circumference of your thigh
is more than 1cm less compared to
the good leg when measured 25cm
above the top of your kneecap.
FOR MORE INFORMATION
Call 01245 234 035