When we think of knee injuries and pain, we often visualize people who play sports or older people who have arthritis, but you don’t have to play sports or be of an age to suffer from knee pain. There are those few who develop knee pain through the activities they do as part of their everyday life, one of them kneeling. It is so common among certain groups that conditions have been named after them. So, kneelers
beware.
The knee is made up of an articulation between the femur, tibia, fibular and patella (kneecap) and is surrounded by muscles, ligaments and four bursae (fluid-filled sacs) that reduce the friction between muscles, bones and the skin. The anatomy of the knee means that when we kneel and pressure is applied to the patella, the bursae play a part in reducing friction and pressure. However, repetitive movements, prolonged kneeling or falling onto your knee can cause them to become inflamed.
The most common conditions that can affect people who kneel are known as housemaid’s knee, carpenter’s knee and clergyman’s knee, but don’t be fooled by their names. You don’t actually have to be a housemaid, clergyman or carpenter to develop one of these painful conditions.
Housemaid’s knee: The technical name for this condition is prepatellar bursitis. It is caused by inflammation of the bursa that sits in front of the kneecap. Its job is to reduce friction and protect the kneecap. It is usually caused by spending long periods of time in kneeling and was commonly seen in housemaids who spent time on their knees, scrubbing floors. However, kneeling isn’t the only way this bursa can be injured; a direct fall onto the knee can cause the bursa to become inflamed, or an infection of the bursa can arise from a cut or scratch, as commonly seen in children. The first signs of housemaid’s knee are pain and swelling which kneeling and walking exacerbate. The knee may be red and tender to touch and, if caused by an infection, you may even have a temperature. But take care as it is not only conscientious housewives who can be affected by this; even children and men are at risk. Believe it or not, the condition is more common in men than women. Men whose work depends on them spending a lot of time kneeling down—carpenters, mechanics and carpet layers, among others—can also develop this condition, although in these cases it is often referred to as carpenter’s knee.
Clergyman’s knee: Also known as infrapatellar bursitis (the bursa that sits just below the kneecap). It is caused by kneeling in an upright position (as in praying—hence the name) and pain and tenderness can be felt just above the knee, and in some cases can radiate down to the calf. But do not think praying on your feet will save you from this condition. It can also be caused by squatting, running and jumping, or by an infection through a cut or open wound. Once the bursa is inflamed, it no longer reduces friction but instead causes pain when going up stairs and bending and straightening the knee.
Treatment for bursitis of the knee will vary, depending on whether it is caused by an infection, overuse or injury. Most times treatment will include RICE (Rest, Ice, Compression, Elevation) to reduce the swelling and speed up recovery. In cases where pain does not lessen and there is reduced range of movement and weakness, physiotherapy can help to regain full function. After a full assessment a physiotherapist will use a range of modalities to ease the pain and increase the range and provide a stretching and strengthening exercise programme to help you get back on your feet.
If an infection has been diagnosed, then the first line of treatment is antibiotics. However, if they prove ineffective then it may be necessary to drain the infected fluid out of the bursa. Draining the fluid is usually achieved through a simple process called aspiration, where a needle is inserted into the bursa and the fluid drawn out. In some cases where pain is not resolving a steroid injection can help but in extreme chronic cases surgery may be indicated to remove the bursa.
Of course, as always, prevention is better than cure. So if you spend a lot of time kneeling it is best to use a cushion or other knee pad to protect the bursa and reduce the risk of developing this painful condition (or prevent it coming back). It is also important to exercise regularly to ensure that you have strong muscles and good range of movement. We tend to spend much more time sitting and relaxing so finding time to add a little exercise to your daily routine can help you not only stay fit but prevent many avoidable problems.
Kim Jackson is a UK-trained physiotherapist with over 20 years’ experience. She specialises in musculoskeletal pain and dysfunction including back pain and sciatica, stroke and other neuro conditions plus sports physiotherapy, having worked with local, regional and international athletes and teams treating injuries and analysing biomechanics to improve function and performance. She is registered with the Allied Health Council and is a member of PASL. She currently works at Bayside Therapy Services in Rodney Bay, O: 458 4409 or C: 284 5443; www.baysidetherapyservices.com
