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Promoting Success in Agriculture for People with Disabilities and Their Families

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Spring 2007 , Vol. 7, No. 3

Table of Contents at bottom PDF Version

Focus – Knee Health

Overview
Knee pain can be quite a disabling condition, whether it is an acute (sudden) injury or the symptoms of a chronic (on-going) condition. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.² Farmers and ranchers subject their knees to significant work-related stress—jumping to the ground from farm equipment or ledges, kneeling for extended periods, lifting/carrying heavy feed/seed bags, walking over uneven or slippery terrain with unsure footing—that ultimately may lead to injury or chronic pain. Studies conducted with dairy farmers in Sweden, England, and the United States showed that arthritis of the hip and knees is more common in dairy farmers than non-dairy farmers, and that diseases of the knee are more frequent and severe than those of the hip.³

Anatomy
A joint is formed where two or more bones meet. The human body has four different types of joints: ball-and-socket, ellipsoidal, hinge, and pivot. The knee is a very complex hinge joint where four bones come together. These bones are the femur (thigh), tibia (shin), fibula (behind shin), and patella (kneecap). See figure 1.

Additional structures include ligaments (hold bones together), tendons (attach muscles to bones), meniscus (provides cushion and smooth surface for movement between bone ends), and bursae (fluid filled sacs that allow tendons and ligaments to slide across for smooth movements). See figure 2.

Risk Factors 
According to the Mayo Foundation, there are a number of risk factors that can affect knee health and are as follows: 5

• Excess body weight
• Overuse
• Decreased muscle flexibility or strength
• Mechanical Problems (i.e. uneven legs, flat feet, etc.)
• High risk sports and certain work activities
• Previous knee injury
• Age (seniors and youth may be more at risk)
• Gender (certain injuries and conditions may be seen more often in females than males, and vice versa)         

Causes of Knee Pain
Knee pain and discomfort affect its strength, flexibility, and function. “Pain can occur in the knee from diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area. In fact, the knee joint is the most commonly involved joint in rheumatic diseases, immune diseases that affect various tissues of the body including the joints to cause arthritis.” ⁴

According to the Mayo Clinic, knee pain can be essentially classified into two different categories—
acute or chronic.⁵ Acute knee problems are usually the result of injury or trauma. Chronic knee pain may result from a medical condition or an injury that leads to ongoing knee pain.  Arthritis is a medical condition that may cause chronic pain. Research by May et al. (2002) suggests that arthritis may be attributed to body weight and physically stressful tasks associated with dairy farm work.³

Treatment
Depending on the severity of knee pain or injury, there are several different treatment strategies that may be indicated—self-directed care, anti-inflammatory medications, or surgery. The first line of treatment for more minor injuries and discomfort is self-directed care. This involves “RICE,” which stands for rest, ice, compression and elevation. A physician will generally start with this treatment if the injury is relatively minor. Rest—Individuals should rest their knee from any further activity to allow it to begin the healing process and protect it from further injury. Ice—Place a cold compress on the affected area to reduce swelling. This is generally done for twenty minute periods over the first 48 hours after injury. Compression—Apply a compression bandage to reduce swelling and increase stability of the injured joint. Elevation—Resting the knee on a pillow or support that is higher than the level of the heart will allow gravity to help drain excess fluid from the joint. 

Over the counter anti-inflammatory medications, such as ibuprofen (Motrin), naproxen sodium (Aleve), or aspirin (Bayer) may help relieve pain while reducing inflammation to the surrounding tissues. Caution should be used whenever administering any medications as side effects and prolonged use may complicate matters. While in circumstances such as rheumatoid arthritis, other medications may be used to promote disease remission. Physical therapy is used to strengthen the muscles, increase flexibility, stability, balance, and range of motion. There have been recent strides around non-surgical interventions for reducing knee pain. These treatments include orthotics (foot arch support); knee braces (provides additional support and stability); glucosamine/chondroitin supplements (may reduce the rate of cartilage deterioration and inflammation); corticosteroid injections (reduces inflammation and provides long-term pain relief); hyaluronic acid injections (reduces inflammation); acupuncture (pain relief); and topical rubs/pain killers (reduces inflammation and provides pain relief).

After all conservative measures have been exhausted or when damage exceeds a conservative approach, surgery may be considered. Many factors must be evaluated in determining if surgery is the most appropriate option and may include: damage, type of injury, lifestyle, risks of further injury by not undergoing surgery, other health conditions, and ability/motivation to participate in effective rehabilitation. Arthroscopic surgery is when tendon, ligament, or meniscus tissue is repaired or reconstructed in hopes of minimizing patient downtime and tissue removal.  Partial knee replacement surgery is recommended when the patient still has some good cartilage in the knee joint but non-surgical treatments failed to help. The surgeon will replace only the most damaged parts of knee joint with artificial parts. The most common surgical treatment for chronic knee conditions in older adults is a total knee replacement.  This procedure is recommended when very little, if any, healthy cartilage is left and non-surgical treatments failed. The entire joint articulating surfaces are replaced by an artificial joint (prosthesis). The surgeon cuts away damaged bone and cartilage and replaces it with a prosthesis made of metal alloys, high-grade plastics, and polymers.⁶ See figure 4. 

You can learn more about total knee replacement by performing a “virtual operation” at:
http://www.edheads.org/activities/knee/index.htm

Summary
When farmers or ranchers start feeling pain or become tired, if at all possible, they should stop what they are doing and rest. Many injuries can be directly linked to fatigue. The body provides signals when it is being stressed or over exerted.

While certain hereditary genetics may be unavoidable, preventive measures can be taken for factors within an individual’s control. Maintaining appropriate body weight, exercising with caution, and using proper body mechanics while working around the farm or ranch are important factors in decreasing the risk of injury to the knees. Look for ways to minimize the stress and impact placed on the knees during heavy lifting and repetitive kneeling, squatting or jumping. Don Padgett, with the assistance of AgrAbility and DRS, was able to reduce the impact and stress applied to his knee joints by installing staircases on the grain bins. By allowing Don to walk to the top of the grain bins, this accommodation decreases the range of motion that would be required by climbing a ladder to reach the top. Plus, the rolling canvas covers allow him to cover the grain trailers from the ground instead of climbing up onto the trailer and jumping back down to the ground. These modifications should slow down the deterioration in Don’s knees and reduce his pain.