Category Archives: Knee

Knee Problems Associated with Snowshoeing

knee problems associated with snowshoeingEnjoying the beauty of the Pacific Northwest on snowshoes is a great way to see the “country” on a beautiful winter day. Snowshoeing was invented sometime between 6,000 – 8,000 years ago; a method of travel for prehistoric people in snow conditions. As you’re climbing a low hill, your moving foot catches the tail of your snowshoe that’s planted and down you go. You feel a tearing pain in your knee. Lying on the ground, you feel your knee swelling like a balloon, and then the agony really starts.

Knee injuries are not uncommon among those who snowshoe.

Falling to one side or sliding downhill while wearing snowshoes can lead to a knee injury because of the torsional forces applied to the joint. Trying to move backwards while wearing snowshoes isn’t really a good idea either; the tail can get caught in the snow and hopefully the only indignity you’ll suffer is landing on your butt. And stepping on the tail of the planted foot with the shoe on the moving foot can result in you landing with your face in the snow and your knee moving in ways that were not intended.

Knee injuries fall into three broad categories: sprains, strains and kneemeniscal tears. Sprains are injuries to ligaments (which attach bone to bone) while strains are injuries to tendons (which attach muscle to bone). You have two menisci in each knee.

The knee consists of four bones: the two lower leg bones (the tibia and the fibula) the upper leg bone (called the femur) and the kneecap (patella). The knee is stabilized by ligaments; the ligament on the inner side of the knee is called the medial collateral ligament (MCL) while the outer is called the lateral collateral ligament (LCL). These ligaments provide left and right stability. You also have two ligaments inside of your knee – the anterior and posterior cruciate ligaments, abbreviated ACL and PCL, which cross from front to rear in an x-fashion. These ligaments provide forward and backward stability.

To complicate things even more, the knee contains cartilage (the same stuff your ears are made of). There are two pieces of cartilage in each knee; each piece is called a meniscus. The cartilage provides a cushion that prevents the tibia from banging into the femur. There is also cartilage lining the back of the patella.

Mechanism of Injury

When one falls while snowshoeing, the knee undergoes a tremendous torsional (twisting) force because the body moves while the foot is planted in one spot. When this occurs, any or all of the following can occur:

  • Sprains, which are tears in ligaments are injuries graded from I to III

o   Grade I: A mild stretching of the ligament with overly stretch fibers

o   Grade II: A partial tear in a ligament

o   Grade III: A complete rupture of the ligament

  • Meniscal tears, which can range from mild to severe
  • Fractures

The first thing to do after a fall is to lie there for a minute and assess your situation. After making sure the rest of your joints are operating properly, focus on the injured knee. A Grade I ligament tear will be painful, but you shouldn’t have much swelling. A Grade II tear is going to result in some swelling and throbbing, while a Grade III tear is going to involve a significant amount of swelling and pain. Since you’ve got two knees, it’s a good idea to compare your injured knee with the uninjured knee. In general, if the two knees look the same and you can move the injured knee without too much pain, you may be able to stand and walk a short distance. As with any injury, it’s best if you flag someone down and have them report your injury to authorities who are trained to manage these types of injuries (another reason to always take a snowshoeing buddy with you).

If you’ve fractured a bone in your knee or leg, you’ll definitely know it; the pain and swelling will preclude walking. If you’ve sustained a fracture, you will need the assistance of trained medical personnel to stabilize your leg and evacuate you so you’ll get proper medical care.

A tear of a meniscus can range from being barely noticeable to incapacitating. If your knee doesn’t hurt too badly, but seems “locked” (meaning that you can’t bend it), you may have possibly torn a meniscus and a piece of it is stuck and is interfering with your knee movement.

Like a meniscal tear, damage to the ACL or PCL can range from minor to severe. If either the ACL or PCL is totally ruptured, you will probably need surgery to repair the damage.

Sometimes a fall can result in a dislocated patella. The patella is the anchoring point for your quadriceps, so if your patella doesn’t “track” or slide well in its grove, the mechanical stability of your whole leg can be compromised. Generally, physical therapy can resolve the problem of a patella that isn’t tracking correctly.

If you sustain a knee injury while snowshoeing, avoid walking if at all possible. If medical help isn’t going to be available, splint your knee with tree branches, rolled newspapers or whatever you’ve got. NEVER try to straighten an injured, bent knee because you can turn a minor problem into something catastrophic. Do not move your knee; if you have a torn meniscus or even a tiny chip fracture and you move your knee, it can create havoc with the inside mechanics of your knee.

How can one prevent knee injuries? The best thing you can do is strengthening your legs by using by exercise. This not only keeps the leg muscles strong and toned, but also keeps your ligaments supple which can minimize the chance of injury. Keep in mind that as you age, your ligaments become less limber, so exercise becomes even more important as you get older.

Keeping in shape, using the proper equipment and keeping common sense foremost can result in the minimization of injury and the maximization of some healthy fun.

Exercises to Strengthen Your Knee


1. High step-up: Place one foot on the floor and the other on a bench about 16” high. Lift yourself to full standing; then lower yourself to the floor. Repeat 15 times, and repeat with the other leg.

2. Lunges: Step out with one leg and bend the other to 900. Step out with the bent leg and bend the other. Walk 15 steps with each leg.

3. Spinal Twist: Place your feet in a comfortable stance. Hold your arms out parallel to the floor and swing one arm forward and the other to the rear. Hold for one minute and repeat with the other arm. Repeat three times.

4. Wall Sits: Place your back against the wall. Slide down until your knees are bent 900 and hold for one minute. Repeat five times.

If you are experiencing knee pain due to a sports injury, please call me at 425-823-400 or email me at to schedule an appointment.


Knee Pain? Learn about Knee Tendinitis

Consider this statement, “Many people who participate in sports or fitness activities will get tendinitis at one time or another.” If you’re an avid athlete or fitness enthusiast like myself, chances are you have felt the discomfort of pain in your knees.

What is tendinitis?

Tendinitis is a persistent inflammation in the tendons. Typically in the knee, this involves the patella tendon between the kneecap and the tibia bone or the quadriceps tendon between the quadriceps muscle and the kneecap. The illiotibial band and the hamstring tendons can develop tendonitis as well. Injuries that do not adequately heal result in persistent inflammation and scar formation.

knee_dr stickneyOveruse is a common risk factor for tendinitis. When the tendon is stretched repeatedly by doing the same kind of exercise over a long period of time, the tendon can become strained and inflamed. Runners often get tendinitis for this reason. Tendinitis can also be caused by intense exercise over a short period of time.  For example, exercising all weekend to make up for the lack of physical exercise during the week. As we age our tendons become more brittle which makes our knees more vulnerable to stress and strain.

Tendinitis is usually treated with therapy, anti-inflammatory medications, and activity modification that allows for healing. Here are some tips to treating knee tendinitis:

  • Rest – Refrain from the activity that caused the tendinitis.
  • Ice – Apply ice wrapped in a towel for 15 minutes once or twice a day. Ice helps reduce swelling, which will lessen knee pain and speed healing of the tendon.
  • Elevate – Lie down and place your knee on a pillow so that it’s higher than your heart. This will aid blood flow and help reduce swelling.
  • Compress – Wrapping the knee in an elastic knee bandage can help reduce swelling and ease knee pain.
  • Ease back into activity – After your tendinitis disappears, don’t immediately go back to the same level of activity that caused your knee pain. Overdoing it can cause a recurrence of tendinitis. Warm up and stretch before beginning exercise. Then go slowly for a few weeks.

If you are suffering from knee tendinitis and would like more information on how to treat it, please call me at 425-823-400 or email me at to schedule an appointment.

Housemaid’s Knee (Prepatellar Bursitis) – Know the Signs and Symptoms

Housemaid’s knee is also known as prepatellar bursitis. It is caused by inflammation of the bursa (a small fluid-filled sac) in front of the kneecap. It more commonly occurs in people who spend long periods of time kneeling. Housemaid’s knee is more common in tradesmen who spend long periods of time kneeling -for example, carpet fitters, concrete finishers and roofers.

Any age group can be affected by housemaid’s knee. It is generally more common in males than in females. Housemaid’s knee in children is more likely to be caused by infection. Infection is also a common cause of housemaid’s knee in people whose immune systems are not working normally; people include those receiving steroid treatment or those on chemotherapy treatment for cancer.

What is bursitis?

Bursitis means inflammation within a bursa. A bursa is a small sac of fluid with a thin lining. There are a number of bursae in the body. Bursae are normally found around joints and in places where ligaments and tendons pass over bones. They can also be found in other places if there has been unusual pressure or friction placed on that area.

Generally, the function of a bursa is to help reduce friction and allow maximum range of motion around joints. When there is inflammation within a bursa (bursitis), the bursa swells due to an increase in the amount of fluid within the bursa sac.


What is housemaid’s knee?

There are four bursae located around the knee joint. They are all prone to inflammation, or bursitis. However, the prepatellar bursa (the bursa in between the skin and the kneecap) is most commonly affected. Its position is shown in the diagram. Housemaid’s knee is the name given to inflammation of the prepatellar bursa.

What causes housemaid’s knee?

There are a number of different things that can cause housemaid’s knee:

·      A sudden, one-off, injury to the knee – For example, a fall or direct blow on to the knee

·      Recurrent minor injury to the knee – This usually happens after spending long periods of time kneeling down, putting pressure on the kneecap (patella). Historically, this was typical of housemaids who spent long periods of time on their knees scrubbing floors; hence, the term housemaid’s knee.

·      Infection – The fluid in the prepatellar bursa sac can become infected and cause inflammation within a bursa (bursitis). This is particularly common in children with housemaid’s knee. This usually follows a cut, scratch or injury to the skin on the surface of the knee. This injury allows germs (bacteria) to spread infection into the bursa.

·      Another inflammatory disease – If you already have an inflammatory disease such as rheumatoid arthritis, you have an increased risk of developing a bursitis. Rheumatoid arthritis is a form of arthritis that causes inflammation, pain and swelling of joints.

·      Gout – If you have gout or pseudogout, you have an increased risk of developing a bursitis. Gout is caused by a build-up of uric acid crystals. Uric acid is a chemical in the blood that is usually harmless and passed out with the urine. In gout, it builds up and collects within a joint, causing pain, inflammation and joint swelling.


How is housemaid’s knee diagnosed?

Dr. Stickney is usually able to diagnose housemaid’s knee simply by examining your knee. He may ask you questions about your occupation or if you have had any recent knee injury and if you have any history of other joint problems.

If Dr. Stickney suspects that housemaid’s knee is caused by infection, he may suggest that they draw some fluid from the bursa. This is a straightforward procedure. The skin on the front of your knee is sterilized with some fluid and the procedure is carried out in a clean environment. A small needle is used to take a sample of the fluid from your prepatellar bursa, which is directly underneath the skin in front of your kneecap. This fluid is sent off to the laboratory to look for signs of infection. If infection is confirmed, the laboratory may be able to suggest which antibiotic medicines will treat it.

Treatment options for Housmaid’s Knee

Episodes’ of housemaid’s knee will settle with medical or supportive treatment unless infected, in which case, your Dr. Stickney may draw fluid, send for lab tests and prescribe some form of antibiotics. Drug or surgical treatment is determined in the treatment plan if the injury is recurring and/or infection is extreme.

If you are suffering from housemaid’s knee, call Dr. Stickney and schedule an appointment at 425-823-400 or email him at