무릎 통증의 원인 

Causes of Knee Pain

 무릎 통증은 모든 연령대의 사람들이 경험하는 가장 일반적인 증상 중 하나입니다. 심한 신체 활동 직후에 일어날 수도 있고, 마모로 인해 시간이 지남에 따라 가벼운 통증으로 시작될 수도 있습니다. 무릎 통증에 대해 의사와  적당한 시기에 상의하는 것이 중요합니다. 

무릎 관절은 허벅지(대퇴골), 정강이(경골) 및 슬개골을 포함한3 개의 뼈로 구성됩니다. 이 세 개의 뼈가 모여서 무릎 관절을 형성합니다. 무릎 관절은 근육, 인대, 힘줄, 반월판, 연골 및 활액낭에 의해 지지됩니다. 반월판은 무릎 관절의 관절 원판이며 충격을 흡수하고 무릎 관절 운동을 돕는 역할을 하면서 관절을 형성하는 뼈의 끝을 보호합니다. 활액낭은 뼈가 수축하고 이완 될 때 힘줄이 뼈 위로 움직일 수 있게 해주는 쿠션 역할을 하는 액체로 채워진 주머니입니다. 인대 및 힘줄은 심한 관절 움직임으로부터 관절을 보호하고 안정시키는 역할을 합니다. 생체 역학적인 변화는 무릎의 통증이나 불편함을 유발할 수 있습니다. 

Knee pain is one of the most common symptoms that people experience at all ages. It may occur right after a physical activity or starts off as a mild discomfort that worsens with time due to wear and tear. It is important to know when to consult with a health care professional regarding your knee pain.   

Knee joint is comprised of three bones: thigh (femur), shin (tibia), and the kneecap (patella). These three bones articulate with each other forming the knee joints. The knee joints are supported by muscles, ligaments, tendons, menisci, cartilage, and bursae. The menisci are articular discs of the knee joint and serve to protect the ends of the bones that form the joint by absorbing shock and aiding in the knee movement. Bursa is a fluid filled sac that acts as a cushion that allows the tendon to move over the bone as it contracts and relaxes. Ligaments and tendons serve to protect and stabilize the joint from severe joint motion. Any biomechanical alterations in the knee can cause pain or discomfort.   

일반적인 증상 : 

• 무릎이 뻣뻣하게 굳는 증상 

• 무릎이 붇고 열이 나는 증상 
• 무릎을 움직일 때 뼈가 갈리거나 터지는 듯한 소리가 나는 증상 
• 무릎을 완전히 펴거나 구부릴 수 없는 (잠김 현상) 상태 
• 무릎이 약해지거나 불안정 해지는 증상 (무릎에 힘이 빠지는 느낌) 

전방 무릎 통증 : 

• 슬개 대퇴 통증 증후군 – 무릎을 굽히거나 필 때 슬개골의 비정상적인 움직임 때문에 통증이 생깁니다. 통증은 한 쪽 또는 양 쪽에 생길 수 있습니다. 계단을 오르내리거나, 걷거나, 달리거나, 오랫동안 앉아있을 때 증상이 심해질 수 있습니다. 
• 슬개 건염 ‘Jumper ‘s knee’ – 힘줄의 염증으로 인해 신체 활동 전후에 발생하는 둔탁한 통증이 발생합니다. 슬개 건염이 악화되면 점프할 때 또는 계단을 오를 때 통증이 급격히 심해집니다. 일반적으로 농구, 배구, 축구 선수에게 많이 발생합니다. 급격히 무릎 운동을 많이 한 후에도 발생합니다. 햄 스트링 근육이 꽉 조이는 성질 때문에, 외반슬 또는 활모양 다리를 가진 사람들에게 슬개 건염이 발생할 확률이 높아집니다. 
• 오즈굿병- 정강이의 슬개골 아래에 오는 통증을 말합니다. 사춘기의 성장 기간 동안 슬개골 삽입구의 뼈는 급속히 성장하는 어린이 뼈에서 성인의 뼈로 바뀝니다. 달리기, 점프, 그리고 급격히 방향을 바꾸는 스포츠를 하면 증상이 심해질 수 있습니다. 힘줄이 뼈를 당겨서 뼈가 덩어리가 되는 지점에 새로운 뼈가 형성됩니다. 

• 활액낭염 – 관절 근처의 뼈, 힘줄 및 근육을 완충시키는 액체가 채워진 작은 패드가 염증을 일으키는 상태를 말합니다. 활액낭염은 일반적으로 과용과 반복적인 운동으로 인한 것입니다. 무릎에 염증이 생길 수있는 여러 가지 점액낭이 있습니다. 

내측 / 내측 슬관절 통증 : 

• 반월판 파열 – 내측 무릎 관절 근처의 반월판이 찢어지면서 통증이 생깁니다. 무릎 관절에는 내측과 외측에 두 개의 반월판이 있습니다. 노화와 함께 종종 내반 반월판의 연골이 찢어져 통증을 유발할 수 있습니다. 통증은 무릎을 구부릴때 더 심해집니다.  
• 인대 결손 – 인대 부상과 관련된 통증을 말합니다. 

외측 / 옆쪽 무릎 통증 : 

• 장경 인대 증후군[ITBS]는 외측 무릎 관절에 통증을 유발하는 장경 인대의 염증입니다. 흔히 통증이 운동을 할 때 심해지고, 움직이지 않으면 멈추게 됩니다 
• 반월판 파열 – 반월판 연골의 파열로 인한 통증입니다. 

후부 무릎 통증: 

• 베이커의 낭종 ‘무릎 낭종’ – 통증이 무릎 뒤쪽에서 느껴지며 오래 서 있거나 활발히 활동한 후에 더 심해집니다. 낭종은 액체를 담고 있는 주머니를 말하며, 크기가 커지고 터질 수도 있습니다. 일반적으로 베이커의 낭종은 그 자체로 증상을 일으키지 않지만, 관련 반월판 파열이나 관절염이 있으면 무릎 통증을 유발할 수 있습니다. 
• 반월판 파열 – 특히 반월판의 뒤쪽이 찢어지는 경우입니다.

위험 요소: 

• 과체중 
• 예전에 있었던 부상 
• 생체 역학적 문제 

• 근력의 약화 

급성 무릎 통증에 대한 자기 관리 : 

• 휴식을 취하고 통증을 악화시키는 운동, 특히 체중을 실어서 하는 활동을 피하십시오. 

• 통증이 시작된 첫 날에는 매 시간마다 최대 20분 동안 얼음 찜질을 하고, 이후에는 하루에 적어도 다섯 번씩 얼음 찜질을 해 주세요.  
• 붓기를 줄이려면 가능한 한 많이 무릎을 올리십시오. 
• 붓기를 줄이고 관절을 보호하기 위해 붕대나 슬리브를 착용하세요. 
• 통증과 붓기에 대해 처방전없이 살 수있는 NSAID를 복용하십시오. 
• 잘 때 무릎 아래 또는 무릎 사이에서 베개를 대고 주무세요. 

과로나 무리한 신체 활동으로 인한 무릎 통증 예방 : 

• 비만일 경우 체중을 줄이세요. 과체중은 계단을 오르내릴 때 일 파운드의 초과 체중당 약 5파운드의 압력을 무릎에 가합니다. 
• 무릎 주위의 근육을 강화하는 운동을 하세요.  
• 운동 전 항상 준비 운동을 하고 운동 후 마무리 운동을 하십시오. 대퇴 사두근과 햄스트링에 스트레칭을 하세요. 
• 언덕에서 아래로 달리지 말고 걸어서 내려가세요.  
• 달리기 보다는 자전거 또는 수영같은 운동을 하십시오. 

• 시멘트가 아닌 트랙과 같이 매끄럽고 부드러운 표면을 달리거나 걷습니다.  
• 발에 문제가 있는 경우 특수 신발 삽입물과 아치 받침대를 사용해보십시오 

 

대부분의 가벼운 무릎 통증은 자기 관리를 통해서 나아질 수 있습니다. 물리 치료나 카이로프랙틱 치료를 받으면 무릎 통증을 없애는 데 도움이 됩니다. 항상 의사와 먼저 상의하세요. 

Common symptoms: 

• Stiffness of the knee  
• Swelling and heat around the knee 
• Popping or grinding noises with movement 

• Inability to straighten or bend the knee fully (locking) 
• Weakness or instability (feels like the knee will give out) 

Anterior Knee Pain:  

• Patellofemoral pain syndrome – Pain is due to awkward tracking of the kneecap during knee flexion and extension. Pain can be unilateral or bilateral. Symptoms can become intense when going up or down the stairs, walking, running, or sitting for long periods of time. 
• Patellar tendinitis “Jumper’s knee” – A dull pain that that occurs before and after activity caused by an inflammation of the tendon. As the tendonitis worsens, the pain becomes sharp with jumping or stair climbing. It typically occurs in basketball, volleyball, and soccer players.  It usually develops after activity is suddenly increased. Having tight hamstring muscles, being knock-kneed or bow-legged increases the chance of developing patellar tendonitis.  
• Osgood-Schlatters – Pain is felt below the kneecap at the shinbone. During the growth spurt in adolescence, the bone at the insertion of the patella tendon changes from a rapidly growing area in children bone to adult bone. Running, jumping and doing sports that require sudden changes of direction can make this area irritated. New bone forms at the point where the tendon pulls on the bone creating a bony lump.  
• Bursitis – A condition where the small, fluid-filled pads that cushion bones, tendons and muscles near the joint become inflamed. Bursitis is typically due to overuse and repetitive motion. There are several bursae that can become inflamed in the knee.  

Medial/Inner Knee Pain:  

• Meniscal tear – Pain near the inner knee joint is due to a tear of the meniscus.  There are 2 menisci in the knee joint, the medial and lateral. Often with aging the medial meniscus can be torn causing pain. Pain is often worse with bending. 
• Ligament tear – Pain and instability associated with injury to the ligament. 

Outer/Lateral Knee Pain:  

• Iliotibial band syndrome [ITBS] is an inflammation of the iliotibial band that causes pain on the outer knee joint. Often the pain gets worse with movement and ceases with rest.   
• Meniscal tear – Pain from a tear on the outer meniscus. 

 Posterior Knee Pain:  

• Baker’s cyst “popliteal cyst” – Pain and fullness is felt in the back of the knee and is worse when standing for a long period of time or after being active. A cyst is a sac that contains fluid and can become large and rupture. Usually Baker’s cyst do not cause symptoms by itself but when associated meniscal tear or arthritis it can cause knee pain. 
• Meniscal tear – Especially if the tear occurs in the back of the meniscus. 

Risk Factors: 

• Being overweight 
• Prior injury 
• Biomechanical issues 
• Lack of muscle strength 

Self-management for acute knee pain: 

• Rest and avoid activities that aggravate your pain, especially weight bearing activities. 
• First day, apply ice every hour for up to 20 minutes and afterwards, at least 5 times per day. 
• Keep your knee raised as much as possible to reduce the swelling. 
• Wear a support bandage or elastic sleeve. This will reduce swelling and provide joint support. 
• Take over-the-counter NSAID’s for pain and swelling. 

• Sleep with a pillow underneath or between your knees. 

Preventing knee pain from overuse or physical activity: 

• Lose weight if you are overweight.  Every pound that you are overweight puts about 5 extra pounds of pressure on your knee when you go up and down stairs.  
• Exercise by strengthening the muscles around the knee.   
• Always warm up before and cool down after exercising. Stretch your quadriceps and hamstrings. 
• Avoid running straight down hills, walk down instead. 
• Bicycle or swim instead of running. 

• Run or walk on a smooth, soft surface, such as a track, instead of on cement. 
• If you have foot problems, try special shoe inserts and arch supports (orthotics). 
• Make sure your shoes fit well, and have good cushioning. 

 

Most minor knee pain will subside with self-care management. Physical therapy and chiropractic treatments can also help relieve the knee pain. Always check with your physician first.